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The “Big Beautiful Bill Act” Is Coming for Your Abortion Coverage
Updated: 6/17/2025
As you’ve probably heard, Donald Trump and congressional Republicans are looking to pass a budget bill that would raise costs for families by cutting Medicaid and nutrition assistance, while providing trillions of dollars in tax breaks to billionaires.
Hidden in this disgusting abomination of a bill (thanks for that one, Elon) is a lesser-known measure that could potentially strip millions of people of insurance coverage for abortion care.
Here’s why that’s a big deal.
The measure, which is in both the Senate and House version of the reconciliation bill, would effectively ban plans under the ACA (also known as “Obamacare”) from covering abortion care in certain states.
Let’s be clear: federal funding is already barred from covering abortion, so any insurance plan that includes abortion care does so without a dime of federal money. But this bill goes even further—it punishes insurers that cover abortion by stripping away crucial cost-sharing reduction payments that make ACA plans more affordable and comprehensive for all kinds of health care, not just abortion.
By telling insurance companies they can no longer receive this vital federal funding if they provide abortion coverage under their plans, Donald Trump and congressional Republicans are giving insurance providers an enormous incentive to weaken their abortion coverage or drop it completely.
Right now, 25 states either require or permit abortion coverage under ACA plans, which is a huge deal for people who live in those states and need abortions. Depending on how far along your pregnancy is, abortions can cost anywhere from $600-$2,000 out of pocket. Insurance coverage can make the difference between someone having an abortion or being forced to remain pregnant.
Here’s how your state might be impacted.
Source: KFF. January 8, 2025. Interactive: How State Policies Shape Access to Abortion Coverage.
First, take a look at this map (courtesy of KFF) to find your state.
- If you live in a RED or LIGHT ORANGE state, this measure won’t impact you because your state already bans abortion coverage in ACA plans.
- If you live in a LIGHT BLUE or DARK ORANGE state, your insurance plans through the ACA marketplace may drop coverage of abortion care altogether if this measure passes. While these states permit plans under the ACA to cover abortion care, it’s not required. This means that without federal cost-sharing, insurance plans may find it too burdensome to keep abortion care under their coverage.
- If you live in a DARK BLUE state, your out-of-pocket costs for insurance plans via the ACA marketplace may go up. That’s because while your state requires insurance to cover abortion under the ACA marketplace, without the federal cost-sharing, insurers may decide to increase the out-of-pocket cost for plans that provide this coverage.
The disruption to insurance coverage this provision would cause would likely extend well beyond ACA plans and could ultimately lead all insurers to drop abortion coverage for all Americans – even those who get their health insurance through their employers.
Who gets hurt the most?
Like most of the budget bill, this measure screws over those who have the most to lose.
The cost of an abortion can be prohibitively expensive. Without insurance coverage, millions of pregnant people may find themselves unable to afford an abortion, particularly those who already struggle to access abortion care, including people who are Black, Indigenous, immigrants, young, have low incomes, have disabilities, live in rural areas, or are LGBTQIA+.
“Leaving it to the states” was always a lie.
Donald Trump repeatedly claimed on the campaign trail that he would leave abortion care to the states.
The proposed measure in his “Big Beautiful Bill Act” is further proof of his hypocrisy. By eliminating federal cost-sharing for plans that include abortion coverage, Donald Trump and congressional Republicans are putting up barriers to abortion in states where this care is still legal.
Their ultimate goal is to put abortion care out of reach for everyone, everywhere, under every circumstance, and this measure is just one step toward that goal.
It was never about leaving it up to the states. That was always convenient rhetoric that would allow these Republican leaders to get elected and then push their anti-abortion agenda through Congress. And it’s working.
